England LMCs have rejected a motion proposing ‘that the time has come to separate acute on-the-day care from planned general practice care’.
Last year, the Fuller stocktake – a landmark review on how to integrate primary care with other NHS services – recommended that urgent same-day appointments should be dealt with by ‘single, urgent care teams’ across larger populations rather than the patient’s own GP practice.
But the notion has been emphatically rejected by LMC delegates, who also threw out proposals for GPC England to negotiate a separate service for the provision of on-the-day acute care for patients currently seen by GPs.
However delegates passed a part of the motion which requested ‘that GPC England negotiates a new GMS contract which focuses on continuity of care, care of long-term conditions, preventative healthcare and end of life care’.
Dr Elliott Singer, presenting the motion on behalf of Walthamstow Forest LMC, argued that GPs ‘do have an unmanageable workload’, and he noted the ‘insanity’ of ‘doing things over and over again, expecting different results’.
‘We don’t have the workforce to see all the patients who believe they urgently need to see a GP,’ he said, adding that a new model could enable the independent contractor model to remain sustainable as a new contract is negotiated.
Speaking against the motion, Dr Emma Watts from Surrey LMC argued it would lead to ‘loss’ ‘of continuity of care’ as well as ‘job satisfaction’; and be a ‘threat to patient safety’.
She also questioned where the estates would come from to house the new acute hubs.
A string of speakers followed her in speaking against the motion, with many passionately echoing the sentiment that it would erode patient continuity and the GP-patient relationship.
However, Dr Rachel McMahon from the BMA’s sessional committee, argued it was ‘insulting’ to suggest GPs working in urgent care hubs would not be able to identify when patients require follow-up care.
Speaking in favour of the motion, she said some GPs were ‘deluding themselves that they are living 20 years ago’.
Some speakers in favour likened the removal of urgent on-the-day care to the removal of out-of-hours from core GP services in 2004.
But speaking on behalf of the GPC, deputy chair Dr David Wrigley warned this motion could ‘break GMS’.
‘This motion could actually enable Claire Fuller’s stocktake and all the concerns we have around that,’ he said.
Although he added that the GPC would be supportive of the part of the motion which argued in favour of a contract focused on continuity of care.
In August this year, Dr Claire Fuller, who led the stocktake, was appointed as NHS England’s new medical director of primary care.
Motion in full
WALTHAM FOREST: That conference believes that the current workload for general practice is unsustainable, and:
(i) believes that the time has come to separate acute on-the-day care from planned general practice care – NOT PASSED (82% against)
(ii) insists that the separation of care be an essential component of a new GMS Contract – NOT PASSED (87% against)
(iii) requests that GPC England negotiates a separate service for the provision of on-the-day acute care for patients currently seen by GPs – NOT PASSED (84% against)
(iv) requests that GPC England stipulates that a new GMS contract clearly indicates the situations when a patient would benefit from moving between acute care services and planned care services and the mechanism to enable this – NOT PASSED (80% against)
(v) requests that GPC England negotiates a new GMS contract which focuses on continuity of care, care of long-term conditions, preventative healthcare and end of life care. – PASSED (61% in favour)